People who inject drugs (PWID) have high HIV incidence and prevalence, and may have limited access to antiretroviral therapy (ART) in some settings. We analyzed baseline HIV drug resistance and antiretroviral (ARV) drug use among PWID enrolled in a clinical study conducted in Indonesia, Vietnam, and Ukraine: HIV Prevention Trials Network (HPTN) 074.
HPTN 074 enrolled 502 HIV-infected index participants who had a viral load ≥1,000 copies/mL; 54 (11%) reported that they were on ART at enrollment. HIV genotyping was performed using the ViroSeq HIV-1 Genotyping System for index participants who had HIV viral loads >400 copies/mL at enrollment. ARV drug testing was performed using a qualitative assay that detects 20 ARV drugs in five drug classes.
HIV drug resistance was detected in HIV from 54 (12.0%) of 449 participants; 29 (53.7%) of the 54 participants had multiclass resistance (non-nucleoside reverse transcriptase inhibitor [NNRTI] + nucleoside/nucleotide reverse transcriptase inhibitor [NRTI] resistance). The most common resistance mutations detected were K103N and M184V. ARV drugs were detected in samples from 51 (11.4%) of the 449 participants: 37 (72.5%) had an NNRTI with one or two NRTIs, 10 (19.6%) had an NNRTI only, and two (3.9%) had a boosted protease inhibitor with one or two NRTIs; two participants had an unusual combination of ARV drugs detected (two NNRTIs and one NRTI). Almost half of the participants who had ARV drugs detected (23/51=45.1%) did not have resistance to at least one of the ARV drugs detected, indicating that they were at risk of acquiring additional resistance mutations. The prevalence of drug resistance was significantly higher among those with ARV drugs detected than in those with no ARV drugs detected (30/51=58.8% vs. 24/398=6.0%, p<0.001). Drug resistance was also detected more frequently among participants in Indonesia (27/112=24.1%) compared to Ukraine (4/165=2.4%; p=0.001) or Vietnam (23/172=13.4%; p=0.014), and among participants who reported a history of incarceration compared to those who did not (6/14=42.9% vs. 48/435=11.0%; p=0.012).
This study revealed a high prevalence of HIV drug resistance and multiclass drug resistance in a cohort of PWID from Eastern Europe and Asia. This is likely to impact use of ARV drugs for HIV treatment and prevention, and highlights the need for improved HIV care in this high-risk population.